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ICD-10 has arrived. Are you there yet?

ICD-10, or the 10th edition of the International Statistical Classification of Diseases and Related Health Problems, is a high-in-detail, more advanced and optimally flexible set of medical terminologies classified by the World Health Organization (WHO).  Post October 1, 2015, the ICD-10 version serves as the current coding norm for all medical services rendered in all identified levels of diagnosis and hospital procedures.

While most information and training modules about ICD-10 are available online, practices need to be more proactive in mastering it at the earliest. MDSprout thought it fit to write about why it is so important, what is the current medical scenario and what you must make sure immediately, so you could better position yourself to kick start the journey:

Why should you switch to ICD-10 as soon as possible?

Firstly, it is mandatory that all HIPAA-covered entities comply with the new code set with dates of service or date of discharge for inpatients occurring on or after October 1, 2015. In fact, the date of ICD-10 implementation has been pushed back for over 6 years and the Department of Health and Human Services has announced that there could be no more relaxation period. Moreover, CMS had recommended much earlier that medical practices must take several years to prepare for implementation of the new code set.

Secondly, staying in the ICD-9 zone would mean that your cash flows will be negatively affected. This is because all ICD-9 codes used in transactions for services on or after the deadline will be rejected by healthcare insurers as non-compliant.

Thirdly, if you have transitioned into ICD-10 partially, then almost all transactions may face compatibility problems with software and contract provisions at the payer’s end, therefore causing delayed or rejected payments.

How is it going to make my medical practice easier?

Like all mandates, there’s a brighter side to ICD-10 compliance. One of its major benefits is a vastly detailed code list with over 14,000 specific codes, the option of sub-classification and the much-needed space for additional data fields. This may seem longer at first sight but with a closer look, you discover that ICD-10 is systematic, clinically more accurate and comes with simple guiding tools that help you find the right codes instantly, without having to search the entire list. ICD-10 also gives you room for unspecified codes, especially in the case of signs/symptoms and external injuries while most EHRs help you translate ICD-9 codes to ICD-10. What’s more? If you look at the code set by specialty, you discover it’s not so long after-all. There is richer dataset for big data analytics and population health management in the long run.

What are some problems that other practices are reported to be facing in the transition?

Since October 1st, 2015, there have been reports that providers are depending on the flexibility provision of the ICD-10 coding system where they use native coding and other via techniques to convert unsupported medical evidence to specified codes. But this may not prove fruitful since they must inadvertently be familiar with the first three digits of ICD-10 codes correctly in order to avoid an automatic denial for CMS claims.  CMS had also warned against such use well before the implementation deadline.

While initial difficulty with learning and using documentation software has been reported by various practices, the emergency department seems to be facing some hindrance in workflow due to its urgent response requirement. With the end-to-end relationship with payers, a surge in technical problems and query communications have been reported. Additionally, the perception that the new code set is complex to comprehend and memorize has led to slower transition and high denial rates of medical necessity diagnosis

But it is important to note that more clarity is expected only a few months post the deadline. Most organizations around the United States have already submitted their first round of ICD-10 claims. Once they receive Explanation of Benefits on these claims, they will be able to assess the exact reasons for payments or denials and may share the information for better awareness in the medical community.

What are some things you should do right away to get on board?

For uninterrupted cash flow, MDSprout’s experts have put together a comprehensive plan that every practice can adhere to. Here are some tips:

Electronic Health Records are critical to success. Practices must make sure that their EHR is upgraded to the latest version with the ICD-10 coding engine, guiding crosswalk,  all other necessary plug-ins and software updates. It is equally important that vendor software and third-party web platforms stay complaint with the payers’ software so that medical billing is brought in line with in-house documentation.

Once all networking systems are updated for use, practices must run a few mock drills to ascertain if there are more technical glitches to fix before using the process in a real-time scenario.  On the administration front, there would be a need to develop fresh policies, update paperwork and medical forms to keep in line with the online transformation.

The most crucial part arrives. Medical practices must train its physicians, staff members and other administrators through holistic education modules on coding and clinical documentation. Short courses on specialty-wise codes and engaging workshops on medical trends are some ways one can achieve this. In fact, the ICD-10 version itself motivates the physician or provider to note detailed daily progress, capturing the complete clinical picture of the patient, which will comply with ICD-10 oriented clinical documentation, EHR entry and finally, successful claims processing . We recommend that you use native coding and unspecified diagnosis in times of doubt or absence of definitive diagnosis, but not entirely depend on it.

On the financial management front, practices can prioritize funding plans for coder education, clinical documentation improvement and medical billing strategies to leverage as much revenue generation as possible.

Overall, practices must be aware that CMS regularly releases clinical rankings and information related to compliance and high performance. To feature in one of the most note-worthy positions on these lists, practices need to put that extra effort to complete their ICD-10 transformation successfully and in a time-bound manner so it may directly reflect in their workflow, quality of services, financial growth and finally, significant reputation in the medical community.

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